Smile Designing

SMILE DESIGNING (PART-I)
PRESENTED BY-
DR. PARTHA SARATHI ADHYA
(1st year PGT, Dept. of Prosthodontics and Crown &
Bridge)
Under the guidance of :-
Prof.(Dr.) Jayanta Bhattacharyya.(H.O.D)
Prof.(Dr.) Samiran Das.
Dr. Sayan Majumdar.
Dr. Soumitra Ghosh.
Dr. Preeti Goel.

CONTENTS
• Introduction
• Need of smile designing.
• Diagnosis
• General facial analysis.
• Analysis of Lip
• Teeth
• Gingiva
• Scientific principles.
• Principles of visual perception and smile design.
• Conclusion

INTRODUCTION
 Smile, a person‟s ability to express a range of emotions with
the structure and movement of the teeth and lips, can often
determine how well a person can function in society. The
goal for esthetic treatment should be an enhanced but natural
appearance that imparts a vibrant and believable appearance
to the patient which also helps to develop a stable
masticatory system, skeletal structures, muscles and joints .
 The application of the principles of esthetics to the natural or
artificial teeth and restorations. –GPT-9
 A concept of using gender, personality, and age as factors in
tooth arrangement and anatomy by means of waxing of casts,
interim composite resin on teeth, or digital image
enhancements. –GPT-9

NEED FOR
SMILE
DESIGNING
DISORDER IN
MORPHOGENESIS
DISORD
ERS IN
CHILD
HOOD &
ADOLOS
CENCE
DISORDERS OF
ADULTHOOD
DISORDE
R OF
DENTAL-
ALVEOLAR
ELEMENT
S

DIAGNOSIS & DIAGNOSTIC TOOLS
o History taking and assessment of the patient-
 Assessment of patients esthetic needs and his/ her
personality and psychology is an integral part of smile dishing.
It is not only helps to know patients esthetic needs but also
helps to identify the problem.
o Inspection-
 Intra oral examination
 Presence of stains, calculus, Gingival health, frenal
attachment should be assessed.
 Presence of carious and non carious lesion.
 Occlusion should be checked, Any type of open bite, cross
bite should be evaluated.

 Extra oral examination-
 Extra oral examination should include assessment of face and lip.
o Radiological examination-
 Iopar and Rvg can be used to detect bone support, caries extent of
individual teeth, peri apical condition of the teeth.
 OPG can be used to detect over all bone condition, presence of
impacted teeth.
 Congenital dentin and enamel abnormality can also be detected by
opg.
 Lateral cephaloghram provides information about maxillary
mandibular growth.
 T-Scan Occlusal Analysis- The T-Scan is a computerized system that
uses sensor technology to identify the location, timing, and relative
force of occlusal contacts.
 Assessment of cast- Assessment of cast provides information about
teeth size, arch space, molar relationship.

Facial beauty is based on standard esthetic principles that involve the
proper alignment, symmetry, and proportions of the face and other dento
facial stuctures. The basic shape of the face is derived from the scaffolding
matrix comprised of the facial and other orofacial stuctures that form the
skull and jaw as well as of the cartilage and soft tissues
that overlay this framework.
MORLEY J et al identified and classified elements of smile design into
 Micro elements.
 Macro elements.
 Microesthetics involves the elements that make teeth actually look like
teeth. The anatomy of natural anterior teeth, size of the teeth, specific
incisal translucency patterns, characterization, lobe development of the
teeth.
 Macroesthetics attempts to identify and analyze the relationships and
ratios between anterior teeth and surrounding tissue landmarks.
(Morley J. The role of cosmetic dentistry in restoring a youthful
appearance. JADA 1999;130:1166-72.)

 General facial analysis:
Facial beauty is based on standard esthetic principles that involve
proper alignment, symmetry and proportion of face.
 The facial perspective is the deciding factor for whether a treatment
is a success or failure. The reason is that from this view, the patient,
his/her family and friends make a physiognomic. (I. Ahmad . Anterior
dental aesthetics:Facial perspective; BRITISH DENTAL JOURNAL
VOLUME 199 NO. 1 JULY 9 2005 ) .
 Morphopsychology- The study of morphopsychology involves
establishing a link between the morphology of the human face with
psychological make-up.
 Facial typology
 Facial zones and segmental expansion
 Sexual type

 Facial typology
 From a typological perspective, faces are assigned to one of four
categories
 Lymphatic (rounded full features with a timid personality)
 Sanguine (prominent thick well-defined features associated with
intransigence and spontaneity)
 Nervous (large forehead, thin delicate features with an anxious
disposition)
 Bilious (rectangular and muscular features coupled with a dominant
personality).
 These factors play a role in determining the tooth size, shape and the
lateral profile; in short, the tooth morphology is dependent on the
facial morphology.
 The lateral profile of an individual can be any one of the following:
1. Straight
2. Convex
3. Concave

o Rickets E-Plane - It is drawn from tip of the nose to the chin. Then the
distance between this plane & the lips is measured. Ideally the upper lip
should be at a distance of 1-2 mm & lower lip at a distance of 2-3 mm from
this plane.
 In class II and class III malocclusion this distance is not maintained.
o Nasolabial angle-This is the angle between columella of nose & anterior
surface of upper lip.
NLA= 90° (Normal)
NLA = <90º (Convex)
NLA= > 90º (Concave)
 In men the nasal-labial angle is generally 90° to 95°, whereas In women it is
generally 100° to 105.9°

 Facial zones and segmental expansion
 The width of the face should be the width of five “eyes”.
 The distance between the eyebrow and chin should be equal to the
width of the face.
 The facial height is divided into three equal parts from the fore head
to the eyebrow line, from the eyebrow line to the base of the nose
and from the base of the nose to the base of the chin.
 The lower part of the face from the base of the nose to the chin is
divided into two parts, the upper lip forms one-third of it and the lower
lip and the chin two-thirds of it.

 The inter pupillary line should be parallel with the horizontal line and
perpendicular to the midline of the face. Also it should be parallel
with the commisure line and occlusal plane.
o Facial midline
 It as vertical line, drawn through the forehead, columella, dental
midline, and chin. (Donovan et al., 1985).
 It is an imaginary line that runs vertically from the nasion, subnasal
point, interincisal point and the pogonion. (Cipra and Wall, 1991 ).

 The dental midline should match with the facial midline. According to
Kokich VG et al The maximum allowed discrepancy can be 2 mm
and sometimes greater than 2 mm discrepancy is esthetically
acceptable so long as the dental midline is perpendicular to the
interpupillary line. However, a canted midline would not be
accesseptable. (Kokich VG,. Maximizing anterior esthetics: An
interdisciplinary approachL Esthetics and Orthodontics. University of
Michigan; 2001).

 Sexual type
 Qualities assigned to biological masculinity and femininity are
importent. Masculine facial features display prominent osseous
structures, angular jaw lines, closed facial angle, and rectangular soft
tissue angles.
 Feminine components encompass delicate osseous make-up, oval
jaws, open facial angle and rounded soft tissues angles.
 A delicate teeth mold signifies famine character and a vigorous mold
signifies masculine character.

 Lip
o Lip length
 The average lip length at rest, as measured from subnasale to the
most inferior portion of the upper lip at the midline, is about 23mm in
males and 20mm in females .
1. short lip- 10-15mm.
2. medium lip- 16-25 mm.
3. long lip- 26-36 mm.
( Roy S. Overview The Eight Components of a Balanced Smile. Journal
of Clinical Orthodoics)
 Lip length affects the visibility of anterior teeth. A long lip reveals very
little anterior teeth where as a short lip reveals more anterior teeth
and denture base.
o Lip form
 There are 3 basic lip phenotypes in humans when the maxillary lip
1. Straight lip .
2. Moderately arched lip .
3. Maximally arched lip
(Cutbirth ST. Importance of lip type classification: maxillary central
incisor length determination versus lip phenotype. Dent Today 2014.)

 Kim et al suggested lip form into 3 type straight, moderate, and high
(Jee Kim et al The influence of lip form on incisal display with lips in repose on
the esthetic preferences of dentists and lay people. J Prosthet Dent 2016)
o An average lip line exposes the maxillary teeth and only the interdental
papillae. A high lip line exposes the teeth in full display as well as gingival
tissues above the gingival margins.

 Teeth
 Dentolabial analysis.
 Exposure of maxillary teeth-
 When the mouth is relaxed and slightly open,3- 3.5 mm of the incisal
third of the maxillary central incisor should be visible in a young
individual. As age increases, the decline in the muscle tonus results
in less tooth display.
 For young woman the value is 3 mm. for middle age group the value
is 1.5 mm below the lip line.
 For older individual the value is 0-1.

 The age and gender of the patient, along with the length and curvature
of the upper lip, will determine the length of the incisal edge.
 The "E" sound is an important parameter when evaluating the length of
the teeth and the incisal line. The maxillary teeth should be displayed
halfway between the upper and lower lip lines while forming this sound
(G. Gurel.The Science and Art of Porcelain Laminate Veneers.)

 The patient is asked to say "Eeeeee" for a few seconds so that the
dentist can observe the position of the maxillary incisors.
 “M” position. By having the patient say the letter “M” repetitively and
then allow his or her lips to part gently, the clinician can assess
minimum tooth reveal
 Incisal curve
 The best position is a convex curve downwards, but it may be
straight or even concave downwards.
 The teeth may be just touching the lower lip or there may be a slight
gap.

o Phonetics
 F and V sounds
 F" and "V" sounds are used to locate the length of the incisors and
the buccal lingual position of the incisal edges.
 While reducing these sounds, the incisal edge should be gently
contracting the vermillion border of the lower lip.
 The length of the incisal edges can be observed from the facial
aspect and from the profile the buccal lingual placement of the
incisors can be evaluated.

 S sound
 During the pronunciation of the "S" sound, the incisal edges of the
mandibular incisors establish occlusal contact with the maxillary
incisors owing to their position, which is 1 mm behind and 1 mm
below the edges of the maxillary teeth.
 The vertical dimension of speech is determined by the "S" sound
formation, when all teeth should be in light contact.
 The mandibular incisals should be in gentle touch with the palatal
surfaces of the mandibular incisors, being 1 mm behind and 1 mm
below.

 Incisor display during speech and smile: Age and gender
correlations.
 Stephanie Drummond, Jonas Capelli Jr.
 Angle Orthod. 2016;86:631–637.
 The purpose of this study was to dynamically evaluate the
exposure of the perioral soft tissues, incisors, and gingival
display during rest, speech, and smile to investigate age- and
gender-related changes.
 total of 265 participants (122 men, 143 women) ranging in age
from 19 years to 60 years were recruited for this study.
Participants were divided into one of the following four age
groups: 19 to 24 years, 25 to 34 years, 35 to 44 years, and 45
to 60 years. Image capture was performed using standardized
videographic methods.

 Rest frame: (1) upper lip length, (2) right lip commissure
height, and (3) left lip commissure height.
 Pronunciation of phoneme “M”: (4) the least exposure of the
maxillary central incisor during speech.
 Pronunciation of the syllable “chee”: (5) the greatest exposure
of the maxillary central incisor and (6) the mandibular central
incisor during speech.
 Posed smile: (7) maximum exposure of the maxillary central
incisor and (8) gingival display.

 With increasing age, there is an increase in the upper lip
length and lip commissures height, particularly in men.
 Aging leads to a significant decrease in the maxillary central
incisor display at rest, speech, and smile, notedly in men.
 A greater display of the mandibular incisor with increasing age
is a common characteristic in both genders.
 Gingival exposure during smile should be considered a
youthful and feminine characteristic

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 Tooth Size and Tooth Form
 Tooth size is determined by mesio-distal width divided by the inciso-
gingival length, which yields the width/length (w/l) ratio
o Maxillary Central Incisors
 The w/l ratio of the central incisor should range from 0.75 to 0.8, a
value less than 0.6 creates a long narrow tooth, and beyond this
number results in a short wide tooth.
 The buccolingual thickness shows wide variance, ranging from 2.5
mm to 3.3 mm for the maxillary central incisors.
 The thickness is measured with a width gauge, at the junction of the
middle third and incisal third of a tooth.

 There are mainly two school of thoughts regarding the size of the
central incisors
 The first is by Rufenacht who proposed morphopsychological
determination of an ideal proportion, and suggested that the width
and length of the central incisor should be constant throughout life.
(Rufenacht C R. Fundamental of esthetics Quintessence Publishing
Co. Inc., Chicago)
 The second theory states that our bodies are in perpetual change
throughout life. When the central incisors erupt, they are pristine with
defined incisal lobes, a textured surface roughness, bright enamel,
with a smaller w/l ratio. During normal functioning, excluding the
effects of disease, the incisal edges wear (resulting in a larger w/l
ratio), surface texture becomes smooth, and the enamel dulls due to
increased translucency Creating teeth with a youthful appearance is
discordant in an older person and creates a sense of artificiality. (I.
Ahmad. Anterior dental aesthetics: Dental perspective. BRITISH
DENTAL JOURNAL VOLUME 199 NO. 3 AUGUST 13 2005 )

o Maxillary Lateral Incisors-
 The maxillary lateral incisors are 2-3 mm lesser in width than central
incisors.
 They influence the gender characterization. For feminine character
lateral incisors are rounded and smooth. But for masculine characteristic
lateral incisors are squarish or cuboidal in shape.
o Maxillary canines-
 the junction between the anterior and posterior dental segments; hence,
only the mesial half of the canine is visible from the frontal view when
the patient smiles.
 The size and characteristic of the buccal corridor is determined by the
size, shape and position of the canine as they support facial muscles.
 Canine are usually longer than lateral incisor by 1-1.5 mm.
 Long cuspal forms denontes aggressive character. Whereas short
rounded blunt cuspal forms denotes soft and passive personality.
o Maxillary bicuspids-
 They play a very important role for arch design. They should fill the
buccal corridor.

 Dental midline-
 To evaluate the midline, one must always consider
1. location and
2. alignment.
 While locating the dental midline The philtrum of the lip is one of the
most accurate of anatomical guide. it should match the papilla
between the centrals. If these two structures match and the midline is
incorrect, then the problem is usually incisal inclination. If the papilla
and philturm do not match, then the problem is a true midline
deviation

 Parallel to the long axis of the face: the line angle that forms the
contact between the centrals should be parallel to the long axis of the
face.
 Perpendicular to the incisal plane: the line angle that forms the
contact between the centrals should be perpendicular to the incisal
plane.
 Maxillary and mandibular midlines do not coincide in 75% of cases.
Therefore, it is not advisable to use the mandibular midline as a
reference point for establishing the maxillary midline. Mismatch
between maxillary and mandibular midline does not affect esthetics
since mandibular teeth are not usually visible while smiling. (M.
Bhuvaneswaran, Principles of smile design. Journal of Conservative
Dentistry, Oct-Dec 2010 , Vol 13 ,Issue 4)

-
 Interdental Contact Areas (ICA) and Points (ICP)
 Contact areas are the places on the proximal surfaces of tooth
crowns where a tooth touches the tooth adjacent to it in the same
arch when the teeth are in proper alignment.
(Operative dentistry modern theory and practice- M.A Marzouk- Indian
edition,2006.)

 Observation suggests that the 50-40- 30 rule is present in between
the contact area of maxillary central incisors, laterals and canines.
 The points where the interdental contact areas end, and the incisal
and distal surfaces of the teeth begin to converge at the incisal
edges, are called the interdental contact points. They move apically
as the teeth proceed from the central incisors to the posterior area.

 Embrasure/Spillways-V” shaped spaces present interproximally
around the proximal contact existing between the adjacent teeth and
are named for direction towards which they radiate.
 Types-
1.Buccal / Labial embrasure
2.Lingual embrasure
3.Incisal/occlusal embrasure
4.Gingival embrasure
 When the dental arches separate, as in speaking or in a smile, a
dark area can be seen in the anterior region between the incisal
edges of the maxillary and mandibular teeth. This negative space
creates a contrast with the teeth that enhances the appearance of
the incisal embrasures.

 The interdental embrasure is the smallest and sharpest in the central
incisors. Continuing the observation posteriorly, the embrasures
become larger and wider.
 The size of the embrasures increases between the premolars. An
angle of 90 degrees can be seen in young, unworn dentitions.

 Buccal Corridor-
 Buccal corridor refers to dark space (negative space) visible during
smile formation between the corners of the mouth and the buccal
surfaces of the maxillary teeth.
 Its appearance is influenced by
1. The width of the smile and the maxillary arch,
2. The tone of the facial muscles,
3. The positioning of the labial surface of the upper premolars,
4. The prominence of the canines particularly at the distal facial line
angle.
5. Any discrepancy between the value of the premolars and the six
anterior teeth.
 Arch form has a direct influence on the buccal corridor.The ideal arch
is broad and conforms to a U shape. A narrow arch is generally
unattractive. The unattractive, negative space should be kept to a
minimum.

 This problem can be solved or minimized by restoring the premolars.
The buccal corridor should not be completely eliminated because a
hint of negative space imparts to the smile a suggestion of depth.
 Inter arch relationships-
o Patients with Angle’s class II and class III malocclusion are
associated with various problems.
o Patients with class II malocclusion are associated with convex facial
profile, increased muscle activity, incompetent upper lip, v shaped
arch.

 In class III malocclusion narrow maxillary arch, lingually tilted
mandibular incisors, large tongue in seen.

 Effect of Gingiva-
 The gingival perspective is concerned with the soft tissue envelope
surrounding the teeth. The gingival texture, shape, tooth-to-tooth
progression and its relation to the extra-oral tissues is interdependent
on many factors influencing smile designing.
o Texture and Position of Gingiva-
 Healthy gingival tissues are pale pink and can vary in degree of
vascularity, epithelial kertinization, and pigmentation, and in the
thickness of the epithelium.
 The papillary contour should be pointed and should fill the interdental
spaces to the contact point. An unfilled interdental space creates an
unwanted black interdental triangle in the gingival embrasure and
makes a smile less attractive. These are known as black triangle.

 The architecture has a positive radicular shape forming a scalloped
appearance that is symmetric on both sides of the midline. The
marginal contour of the gingival should be sloped coronally to the
end in a thin edge.
 The texture of the tissues should be stippled.
 A normal, healthy gingival sulcus should not exceed 3 mm in depth
o The gingival contours-
 The gingival contours should be symmetric and the marginal gingival
tissues of the maxillary anterior teeth should be located along a
horizontal line extending from cuspid to cuspid.

o Zenith points
 Zenith points are the most apical position of the cervical tooth margin
where the gingiva is most scalloped. It is located slightly distal to the
vertical line drawn down the center of the tooth. The lateral is an
exception as its zenith point may be centrally located.
 But for the lateral incisor and mandibular incisors zenith point may be
centrally situated, making it an exception.
 The gingival aesthetic line (GAL) is a classification for creating
pleasing gingival level transition between the maxillary anterior teeth.
GAL is defined as a line joining the tangents of the zeniths of the
FGMs of the central incisor and canine.

 The GAL angle is that formed at the intersection of this line to the
maxillary dental midline.
 Assuming a normal w/l ratio, anatomy, position and alignment of the
anterior dental segment, four classes of GAL are described:
 Class I: The GAL angle is between 45º and 90º and the lateral incisor
is touching or below (1- 2 mm) the GAL.
 Class II: The GAL angle is between 45º and 90º but the lateral incisor
is above (1-2 mm) the GAL and its mesial part overlaps the distal
aspect of the central incisor. This situation isoften seen in Angle’s
Class II or pseudo-Class II conditions

 Class III: The GAL angle = 90º, and the canine, lateral and central
incisors all lie below the GAL.
 Class IV: The gingival contour cannot be assigned to any of the
above three classes The GAL angle can be acute or obtuse. A
myriad gingival asymmetries are apparent clinically including:
recession, passive and altered passive eruption, eccentric eruption
patterns, loss of interdental papillae, clefts and high frenal insertions.

o Gingival Zenith Positions and Levels of the Maxillary Anterior
Dentition.
o STEPHEN J. CHU, JOCELYN H-P, CHRISTIAN F.J.
 J Esthet Restor Dent 21:113–121, 2009
 This investigation evaluated two clinical parameters: (1) the gingival
zenith position (GZP) from the vertical bisected midline (VBM) along
the long axis of each individual maxillary anterior tooth; and (2) the
gingival zenith level (GZL) of the lateral incisors in an apical-coronal
direction relative to the gingival line joining the tangents of the GZP
of the adjacent central incisor and canine teeth under healthy
conditions.
 A total of 240 sites in 20 healthy patients (13 females, 7 males) with
an average age of 27.7 years were evaluated.
 Alginate impressions of the study group were made were
immediately poured with stone.
 To define the VBM of each clinical crown, the tooth width was
measured at two reference points. The proximal incisal contact area
position and the apical contact area position served as the reference
points.

 Each width was divided in half, and the center points were marked.
 The highest point of the free gingival margin was also marked.
 All central incisors displayed a distal GZP from the VBM with mean
displacement of 1 mm. VBM. For lateral incisors, 65% of the
population showed a distal displacement of GZP from the VBM, and
35% showed that the GZP was concurrent and centralized along the
vertical axis of the tooth.
 Only 1 of 40 canine sites (2.5%) showed a distal displacement of
GZP from the VBM .

 Smile and Smile zone-
 The inferior border of the upper lip and the superior border of the
lower lip form an outline of the space that is revealed when smiling
.This space that includes the teeth and tissues is called the smile
zone .
(Nicholas C. Davis. Smile Design. Dent Clin N Am 51 (2007) 299–318)

 Smile line refers to an imaginary line along the incisal edges of the
maxillary anterior teeth which should mimic the curvature of the
superior border of the lower lip while smiling.
 Reverse smile line is seen when central incisor are smaller than
canines.
Lip line –It refers to the position
of the inferior border of the upper
lip
during smile formation and
thereby determines the display
of tooth or gingiva at this hard
and soft tissue interface.
• ideally the gingival margin and
the lip line should be
congruent or there can be a
1–2 mm display of the gingival
tissue.
• In gummy 3-4 mm or more
gingiva can be seen.

SCIENTIFIC PRINCIPLES
 The Golden Proportion-
 The golden proportion has been used since time immemorial and
was formulated as one of Euclid’s elements.
 Euclid showed how to divide a straight line by means of the golden
proportion; Kepler called it the “Divine Proportion.”
 Leonardo da Vinci illustrated a dissertation by Luca Pacioli on the
golden proportion in 1509. and he made drawings of his independent
studies.
 The American mathematician Mark Barr called the ratio PHI.

 Lombardi was the first to propose the application of the golden proportion in
dentistry, stating, ‟it has proved too strong for dental use‟ also he defined the
idea of a repeated ratio which implies that in an optimized dentofacial
composition from the frontal aspect, the lateral to central width and the
canine to lateral width are repeated in proportion.
 Application of golden proportion to dental esthetics was first documented by
Levin in 1978.
 When the ratio between B and A is in the golden proportion, then B is 1.618
times larger than A.
 In order to be able to asses the Golden Proportion quickly and accurately an
instrument, the golden mean gauge can be used or a golden link caliper,
developed by Shumaker also can be used.

o Application of golden Proportion-
 A vertical golden proportion should be present between upper lip and
lower lip.
 The total lip height should be in golden proposition to the philtrum.
 The golden proportion is present from the chin (menton) to the lip
embrasure (stomion) to the alar rim (al) of the nose.
 one nostril compared to the central columella and the nostril on the
other side follows the golden proportion.

 The width of the nasal bridge is found golden to the width of the
lateral nares.
 It has been noticed that there exists another compound golden
proportion in which the width of all the 6 anterior teeth together are in
the golden proportion to the width of the smiling lips.
MAXILLARY
TOOTH
GOLDEN PROPORTION RATIO GOLDEN %
CALCULATION(RATIO)
Right canine 0.618 0.618/6.472 (10%)
Rt lateral incisor 1.000 1.000/6.472 (15%)
Rt central incisor 1.618 1.618/6.472 (25%)
Lt central incisor 1.618 1.618/6.472 (25%)
Lt lateral incisor 1.000 1.000/6.472 (15%)
Left canine 0.618 0.618/6.472 (10%)
Total 6.472 6.472/6.472 (100%)

 Thee all 6 maxillary anterior teeth are 1.618 part larger than lower 4
incisors.
 Dr. Stephen MarQuadt discovered golden proportion for maxillary
central incisors . According to him the height of the central incisor is
in golden proportion with the width of the two central incisors.

o Golden proportion assessment between maxillary and mandibular
teeth on Indian population.
o V Rangarajan,N. Gopi Chander, Vaikunth Vijay Kumar.
o J Adv Prosthodont 2012;4:72-5.
 This study evaluated the existence of golden proportion between the
widths of the maxillary and mandibular anterior teeth in Indian
population.
 The flat end of digital caliper is used to measure the widths of the
maxillary central, lateral and canine, mandibular central, lateral and
canine.
 The width of maxillary and mandibular anterior teeth arch width was
measured using a flexible ruler. The widths of the teeth were
measured at the mesio-distal contact points of teeth .
 The golden proportion for each subject was assessed by multiplying
the width of the larger component by 62% and compared the width of
the smaller component for proportion to be analyzed.

 The golden proportion was not found between the width of the right
central and lateral incisors in 53% of women and 47% of men. The
results revealed the golden percentage was rather inconstant in
terms of relative tooth width.
 This study inferred that golden proportion between the widths of
maxillary and mandibular teeth was not observed in the majority of
Indian population

 RED Proportions-
 The RED proportion states that the proportion of the width of the
teeth should remain constant as a person moves distally when
viewed from frontal surface.
 The idea of a continous proportion or repeated ratio as defined by
lombardi opens up the idea of continous proportion not necessarily
limited to 62%. This idea implies however the ratio of the widths
established between the central and lateral incisors then must be
used as one moves distally.

 The use of RED proportion gives more flexibility as it ranges from 62%
to 80%.
 It is recommended that the taller the individual and taller the teeth, the
smaller the RED proportion. Extra tall individuals should have a 62%
RED proportion, normal height persons a 70% RED proportion, and a
very short person an 80% RED proportion.
 A study comparing different RED proportions with different heights of
teeth found preferred w/l ratio of the resulting central incisor in the 75%
to 78% range. (Lombardi RE. A method for the classification of errors in
dental esthetics. J Prosthet Dent 1974;32:501–13)

 When using the RED proportion, the ICW is used to determine the
ideal width of the central incisor. The formula for determining the
ideal width of the central incisor is CIW =ICW/2 (1+RED+RED²).

 CHU’S ESTHETIC SCALE-
 Dr.Chu‟s research supports Levin‟s RED concept and refutes the
golden proportion. Chu’s esthetic gauges also called proportion gauge
enables an objective mathematical appraisal of tooth size rangers in a
visual format for the clinician.
 It is composed of
 The Proportion Gauge
 The Crown Lengthening Gauge
 The Sounding Gauge
 Proportion Gauge
 Helps to measure the tooth width and length.
 The instrument measurements have a predetermined ratio of about
78%.
 The clinician will be able to diagnose any tooth size and proportion
discrepancies that require correction to enhance patient aesthetics.
 Comprises of – T-bar tip (regular alignment)
In-line tip ( crooked/crowded alignment

 The T-bar tip is designed to measure the width [horizontal arm] and
length [vertical arm] of a maxillary anterior tooth simultaneously.
 The most common width/length numbers for the lateral (blue band),
canine (yellow band), Central (red band) are 6.5/8.5, 7.5/9.5 and
8.5/11mm respectively.

 In-line tip Indicated to be used on crowded teeth where the use of T-
bar tip may be difficult.
 The tip is designed to measure the width [shorter arm] and length
[longer arm] of the of the maxillary anterior teeth, independently.
 The Crown Lengthening Gauge
 Used for crown lengthening procedure.
 BLPG tip is used to achieve the proper clinical and biologic crown
length during crown lengthening procedure.
 Papilla tip is used to achieve an aesthetically ideal position of the
interdental papilla during the crown lengthening procedure.

 The BLPG tip is designed to measure the midfacial length of the new
restored clinical crown and the length of the biologic crown [bone
crest to the incisal edge], simultaneously.
 The instrument is color-coded with a preset dentogingival complex
measurement of 3 mm. This helps achieve the ideal 3mm difference
between the clinical and the biologic crown length.
 The color bands on the shorter arm representing clinical crown
length portion are aligned to the corresponding color bands on the
longer arm representing the biologic crown length of the instrument.

 The Papilla tip is designed to measure the interdental length of the
new restored clinical crown and the length of the biologic crown
[bone crest to the interproximal incisal edge].
 The tip is color coded with a preset length color ratio of 60% from the
incisal edge to achieve an aesthetically ideal papilla position.
 The color bands on the shorter arm representing the interproximal
papilla position are aligned to the corresponding color bands on the
longer arm representing the interproximal biologic crown length

 The Sounding Gauge
 Provides quick, simple analysis of the bone crest location both mid-
facially and interdentally.

 The M Rule-
 It was developed by Dr. Alain Méthot.
 It has been shown that this Golden Rule cannot be universally
applied to all patients, it therefore became necessary to adapt or
modify this Golden Rule by individualizing the formula according to
each patient.
 This modified Golden Rule has been achieved by application of a
mathematical formula elated to the
1. inter-molar distance of each patient, representing the width of the
arch, and
2. the width of the central incisors to determine the correct balance for
the teeth displayed within that arch to create a pleasing smile.
 During the process of the invention, subjects where analysed using
the “Guided Positioning Software” program which uses this “M”
Proportions Ruler.

 All the subjects studied fell within a certain ratio of 1.25 to 1.618 with
the majority of the cases falling in the 1.38 area and only very few
cases being found at the lower and higher ratio extremes. The 1.38
ratio has been labelled as the Reference Ratio. (Dr. Alain Méthot.
The new Golden Rules in dentistry. Canadian journal of cosmetic
dentistry.)
 It may be observed that the greater the inter-molar distance, the
smaller the “M” Proportion ratio becomes.

• It is crucial to take the photograph directly in front of the subject
demonstrating a full natural smile at a focal distance of 1:10.

PRINCIPLES OF VISUAL PERCEPTION AND SMILE DESIGN
 Composition:
 The study of the relationship existing between objects made
visible by contrasts in line, colour and texture is called
composition.
o Symmetry-
 The objective of prosthodontist is to provide a dynamic unity
and not a static one.

o Proportion
 is a valuable tool to provide symmetry with variety , i.e. if two teeth
are of the same width but different lengths , the longer teeth will
appear to be narrower.
o Dominance
 Is the factor required to provide symmetry, i.e. one tooth must
dominate in the anterior tooth arrangement, by virtue of its size
central incisors being the right choice. The central incisor must be
larger than the lateral incisor to dominate the composition.

o Balance
 Its denotes the stability resulting from quilization of opposing forces. In
other words, it is called as equilibrium.If a structural map of lip is drawn,
then the most stable point is at the intersection of the structural axes.
 When a question arises about the placement of the midline, either in the
middle of the head or the middle of the mouth, the answer according to
balance should be at the point where it remains stable, which is mostly
the imaginary midline that divides the philtrum of the upper lip. However,
the midline cannot be measured, but a long contemplative look will
reveal the position of the midline as eye is a competent evaluation

o Illusions
 Several basic principles of illusion, such as those used to describe form,
light, shadow, and line, may be applied specifically to dentistry.
 Illusions in dentistry are created using three techniques:
1. Shaping and contouring.
2. Arrangement of teeth.
3. Staining.
 Shaping and contouring
 The basic principles of illusion concerning shape and outline form are:
1. Vertical lines accentuate height and de-emphasize width.
2. Horizontal lines accentuate width and de-emphasize height.
3. Shadows add depth.
4. Angles influence the perception of intersecting lines.
5. Curved lines and surfaces are softer, more
pleasing, and perceived as more feminine than sharp angles.
6. The relationship of objects helps determine appearances.

 Arrangement of Teeth
 Lombardi offers good, simple advice for those taking the first steps in
altering tooth arrangement. His One, Two, Three Guide includes
incisal modifications.
 One refers to the central incisor, which expresses age; Two to the
lateral incisor, which expresses sex characteristics; and Three to the
cuspid, which denotes vigor. This guide shows how to use the
“negative”.
Goldstein RE. Esthetics in Dentistry. Philadelphia, PA: JB Lippincott;
1976.

 Staining
 Staining may be used not only to duplicate the natural variations in
tooth color but also to create and enhance illusions through
manipulation of shape and surface characterization.
 There are two basic aspects of color that you can use to create and
enhance illusion
1. By increasing the value of the color (increasing whiteness) you will
make the area to which it is applied appear closer.
2. By decreasing the value of the color (increasing grayness) you will
make the area to which it is applied appear less prominent and
farther away.
Goldstein RE. Esthetics in Dentistry. Philadelphia, PA: JB Lippincott;
1976.

o PINCUS PRINCIPLES
 One of the major contributions of Dr. Charles Pinks importance was
the discovery of light reflectance, surface texture and contour of
teeth.
 According to him 3 properties of light are important these are
1. Direction of light
2. Movement of light
3. Color of light.

o Porcelain crowns and bridges should be fabricated so that the
surface texture, including the convexities and concavities,
matches the enamel surfaces of the adjacent natural teeth.
o Doctors create illusions to obtain the appearance of larger,
smaller, longer, or shorter teeth in the same place. This is
achieved in part by varying the outlineform of teeth.
• Different Outline form of teeth changes the character of light
as the result of the changes in direction and movement of
light.

SMILE DESIGN- A MULTIDISCIPLINARY
APPROACH
 Analyzing, evaluating, and treating patients for the purpose of
smile design often involve a multidiscipline approach to
treatment. Specialty treatment for achieving an ideal smile can
include orthodontics; orthognathic surgery; periodontal
therapy, including soft tissue repositioning and bone
recontouring; cosmetic dentistry; and plastic surgery. This
esthetic approach to patient care produces the best dental
and dental–facial beauty

 ROLE OF PEDODONTIA
• Early diagnosis of dentofacial problems are identified by
Pedodontist.
• Pediatric treatment prevents early loss of teeth, help to
maintain inter arch space.
• Treatment of oral habits, early dental and skeletal abnormality
are done by pedodontist.
 Role of orthodontia
• Preventive orthodontics mainly focuses on treating
malocclusion at an early age than letting it going worse.
• Corrective orthodontics treats dental and skeletal
abnormalities.

 Role of periodontics
• Marinating overall oral health.
• Frenectomy, crown lenthning done by periodonttist.
 Role of oral & maxillofacial surgery
• Corrective orthognatic surgeries are done by oral surgeions.
 Role of endodontia
• Helps to maintain loss of teeth by restoring teeth.
• Endodontics treatment prevents extractions.

REFERENCES
 Mohan Bhuvaneswaran. Principles of smile design. J Conserv Dent . 2010 Oct –
Dec; 13(4): 225-232.
 Sabri R. The eight components of a balanced smile . J Clin Orthod.2005;
39(3):155-66.
 Ward DH. Proportional smile design using the recurring esthetic dental (RED)
proportion. Dent Clin North Am. 2001; 45:143-154.
 Lombardi R. The principles of visual perception and their clinical application to
dental esthetics. J Prosthet Dent 1973; 29:358-381.
 Goldstein RE. Esthetics in Dentistry. Philadelphia, PA: JB Lippincott; 1976.
 Nicholas C. Davis. Smile Design. Dent Clin N Am 51 (2007) 299–318).
 Operative dentistry modern theory and practice- M.A Marzouk- Indian edition,2006.
 I. Ahmad. Anterior dental aesthetics: Dental perspective. BRITISH DENTAL
JOURNAL VOLUME 199 NO. 3 AUGUST 13 2005.
 Cutbirth ST. Importance of lip type classification: maxillary central incisor length
determination versus lip phenotype. Dent Today 2014.
 G. Gurel.The Science and Art of Porcelain Laminate Veneers

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